Diathermy



F. M. ENDE July 14, 1931.

DIATHERMY Filed May 4, 1928 Patented July 14, 1931 UNITED STATES FRANK M. ENDE, F NEW YORK, N. Y.

DIATHERMY application med May 4, 1928. serial No. 275,154.

My invention relates to diathermy, and especially to an improved electrode and for producing localized coagulation of tissue.

In applying diathermy using the usual in- 'Y different and active electrodes, the-latter in Contact with the part to be treated, and the former applied to the patients buttocks or elsewhere, the degree of tissue destruction and the area actually destroyed is difficult to control with the certainty required to keep within the narrow limits permissible.

Causes for this are numerous. The electrical resistance between the inactive and active electrodes varies in different individuals and in different locations with a single individual. Changes and variations in the area of Contact between the active electrode and the tissue to which it is applied produce corresponding variations in current .density and cause the degree of tissue destruction to vary. Where the active work on tissue is out of sight, as, for example, in the cervical canal, the degree of destruction is beyond the control of the operator, because of his inability to see the area of coagulation as it forms, and

application of diathermy treatment may result in areas of excessive destruction and re'- sulting excessive scar tissue formation, and even in circular scar formation and resultant narrowing of the lumen of the canal (stric- ,ture

I )have discovered that very greatly improved and closely regulable results .in respect of depth, extent, and uniformityl of destruction of tissue can be obtained by making the application of the high frequency diathermy current to the tissue through a pair of active electrode elements of known size and known spacing. whereby the path of 0 current from one to the other is confined to the strip of tissue between these electrodes, and use of an indifferent electrode is elimi` nated. i lVhen the high frequency current is supplied by means of such electrodes connected to the poles of the diathermy machine, tissue destruction can be regulated over a definite arca and in such closely controlled fashion as to obtain the best results for localized tissue destruction and for subsequent healing.

In the accompanying drawings, I have shown apparatus by which my invention can be carried into effect, but it is to be understood that same is only for the purpose of affording an understanding of the invention and not for imposing limitations thereon.

In said drawings, Fig. v1 is a longitudinal cross-sectional view of a handle for receiving a removable electrode tip. Fig. 2 is a perspective showing the handle of Fig. 1 with a cervical electrode tip `in place therein. Figs. 3 and 4 are enlargedl views of the cervical tip of Fig. 2. Fig. 5 is a section on approximately the line 5-5, Fig. 4. Figs. 6 and 7 are views of some of the numerous modified forms of tips that can be used; and Fig: 8 is a side view of a dummy tip.

Reference character 10 designates a handle comprising a plug 12 having a pencil or rodr 14 `connected thereto as by means of p 'screws 16, and the spaced-apart insulated "wires 18, 18 extending therethrough, and

terminating at each end in jacks, the jacks 20, 2O at the plug end being adapted for connection of lead wires 22, 22 from the two poles of lthe standard diathermy machine, and the jacks 24, 24 atthe other end adapted to receive wires 26, 26 projecting from removable tips, as the cervical tip 28, preferably made of molded insulating material which will not deteriorate when washed or immersed in antiseptic solution. The projectin'g wires 26, 26 communicate with theelectrodesY 30, 30 which are preferably 4partially imbedded in the lateral surface of the tip 28 so as to be spaced a uniform distance apart, preferably about 1/8. l/Vhen tips containing these active electrodes are made of molded insulating material, the electrodes can be partially imbedded therein, except for the relatively small protruding portions, in

l the course of molding. The cervical tip 28 is preferably of tapered substantially pencillike formation and is graduated, preferably in units of l@ inch, as indicated at 32, enabling the depth of the cervical canal to be measured by the graduations on the tip. The rod 14 can be provided with a spline 34 to enter a splineway 36 on the several tips adapted to coagulation inasmuch as the reading of the milliammeter with which all diathermy machines are equipped is merely a rough indication of theA output and cannot be used as a basis of diathermy dosage.

From extended experimentation and observation, I have found that when the current of a machine is applied to the albuminous trial material .hereinafter referred to for a sufficient length of time to show a white strip of coagulated material against the black background of the dummy tip (the dummy tip is black for this purpose), the

application of the cervical tip to 'the cervical l tissue for a like length of time will produce tissue destruction tothe depth of about one millimeter, which is a desirable depth in practice.

In Fig. 8 of the drawings, I have shown what I' prefer to call a dummy tip 38, which is like'the tipalready described except that it is 'substantially cylindrical'throughout its length and is provided with an adjustable stop, which in the form shown consists of a perforated rubber stopper 40. The dummy tip 38 is preferably of dark colored or black molded insulating material and is graduated, preferably in quarter inches, like the tip 28, for convenient noting of the extent of protrusion beyond the stop 34.

With the depth of the cervical canal measured preliminarily by insertion therein of the cervical tip 28, same is removed from the handle 10 and replaced by the dummy tip and the stop 4() adjustedto a position on the dummy tip to expose a length of active electrodeequal to the length of the canal which has been measured. The measured protruding portion of such dummy tip is then referably immersed in egg albumen to Whic has been added suicient chloritone, or equivalent thereof, so that it will be preserved from decomposition and at the same time its electrical resistance is lowered to approximate the resistance of the cervical tissue.

The diathermy current is turned on and continued a suiiicientlength of time to coagulate a strip of albumin coming in contactwith the dummy tip and lying between the two active electrodes to an extent to show 'white and entirely opaque against the black background of the dumm tip material. The time period of current ow for the accomplishme'nt of this coagulation is auged,

T e output of t e machine is; then properly adjusted so that suiiicient power is, used to co agulate a one-inch strip in. fourfseconds, so that other cases may be treated on a basis .tion of the machine output by means of the vactive electrodes of my cervical tip having the same exposed electrode area and spacing as in the dummy tip.

` The cervical tip 28 with the electrodes parallel and spaced with relation to one another at a predetermined distance apart as described, which distance remains unchanged during use for tissuecoagulation, is adapted for producing the destruction of the tissue along a strip line, the strip being of the length of the exposed portion of the electrodes that are in contact with tissue and of a width correspnding to their distance apart. The complete uniform application to the cervical canal, for example, may be made by producing a series of strip destructions of tissue orrdiffusely by rotation of the tip over a. period of time which has been gauged in advance in the manner above described. It will of course be understood that when this gauging hasbeen donefor a given machine it is unnecessar to be repeated in its operation thereafter, .i the ammeter is read with the tip short-circuited,4 though check gauging may, of course, be resorted to from time to time if deemed necessary. By short-circuiting for readin the shorted output on the am n1eter, I am a le tosay that the machine in question will coagulate cervical canal one millimeter dee .when exposed one second per guarter-,inch o introduction if the machine is rst shorted and the output adjusted so that the meter reading is identical with that obtained by shortening the machine immediately after its successful operation on albu- `its end, and these ball-shaped electrodes, which are preferably about lg inch in diameter, can be a somewhat greater distance apart than in case of the elongated electrodes of the cervical tip 28. This arrangement of electrodes is adapted for destruction of tissue on an exposed surface, such as the surface around the mouth of the cervical canal, for example.

Numerous other forms of active spaced electrodes may be made use of in accordance With my invention. In Fig. 7 I have shown the tip 54 having electrodes 56, 56 of needle form.l These sharp-pointed needle electrodes are designed to perforate the tissue and may have a slidable collar back of their points,

as indicated at 58, so as to provide a stop to limit the extent of penetration. Elec- -.trodes of this type are of utility, for example, in connection with the step-by-step destruction of a ring of tissue surrounding a part or a neoplasm which is to be removed.`

I claim:

1. Therapeutical apparatus for destruction of tissue by high frequency current comprising bipolar electrodes, means for supporting same at a predetermined distance from each other, which is a small fractional part of an inch, so that such distance remains fixed during use, means for connecting up said electrodes to complete thepoutput circuit of a source of high frequency electrical current through tissue intervening between and in contact with the electrodes, and a non-con ducting handle. 2O 2. Apparatus as in the preceding claim, in

Which the electrode supporting means comprises a substantially pencil-like non-conductor, and the electrodes are arranged to ex` tend substantially parallel along substantially the surface of said non-conductor.

3. Apparatus as claimed in claim 1 in which the bipolar electrodes are carried in a separable jack member whereby desired pre determined spacing and conformation of electrodes can be secured by jack replacement.

In testimony whereof, I have signed my name hereto.

FRANK M. ENDE. 

